Organization
JADE VINE MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANNAH CAMILLA NUSBAUM LMT (OWNER)
(907) 394-8645
Entity
Organization
Contact information
Practice address
43335 KALIFORNSKY BEACH RD STE 25, SOLDOTNA, AK 99669-8280
(907) 394-8345
(907) 283-5350
Mailing address
1413 COURTNEY DR, KENAI, AK 99611-6646
(907) 394-8345
(907) 283-5350
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
121821
AK
Other
Enumeration date
11/01/2017
Last updated
11/01/2017
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